電刺激於脊髓損傷患者排尿功能障礙之應用

Electric Stimulation for the Bladder Dysfunction in Patients with Spinal Cord Injury

王昭閔(Chao-Min Wang) ； 王顏和(Yen-Ho Wang)

《台灣復健醫學雜誌》 37卷1期 (2009/03) Pp. 1-17

https://doi.org/10.6315/2009.37(1)01

摘要

排尿障礙對脊髓損傷患者造成極大的影響，除了導致日常生活不便，更有可能發生危及生命的併發症。傳統處理排尿障礙的方式有留置導尿管、乾淨間歇性導尿、外接尿袋與膀胱擴大術等。近年來應用電刺激於治療脊髓損傷患者的排尿障礙，具有相當成效。針對膀胱排空障礙與膀胱貯存障礙，以不同類型的電刺激施用於不同的部位。電極可以固定在脊髓、神經根、周邊神經、膀胱及表面皮膚等位置，有的需手術植入，有的可以細針插入，也有的可使用黏貼電極。薦前神經根電刺激是目前接受度最高的治療方式，可使患者排空膀胱，但由於逼尿肌括約肌共濟失調的干擾，排尿情形並不穩定，而施行薦後神經根切斷術可以減緩此困擾。另外薦神經調節、背陰莖神經電刺激與經皮神經電刺激也可減輕膀胱過度反射的症狀。目前電刺激已成爲治療脊髓損傷患者排尿障礙的一種新選擇，在未來臨床治療與研究上，是值得進一步發展的範疇。

關鍵字

電刺激 ； 脊髓損傷 ； 排尿功能障礙

並列摘要

Bladder dysfunction makes huge impact on the patients with spinal cord injury. It not only causes inconvenience in daily living, but also leads to many complications, including life-threatening renal failure. Traditional methods had been brought into greater use for the management of bladder dysfunction, such as indwelling catheter, clean intermittent catheterization, external condom catheter, bladder augmentation and so on. Electric stimulation is an effective treatment for both bladder voiding and storage dysfunction and it can be used in many different location. The electrodes can be placed on spinal cord, nerve root, peripheral nerve, bladder and skin by surgical implantation, needle insertion and adhesive pads. Sacral anterior root stimulation is the most efficacious technique so far and patients can void well with stimulation. However, detrusor-sphincter dyssynergia interferes with bladder emptying. Although sacral posterior rhizotomy can reduce the resistance, this problem can not be solved completely. In addition, sacral nerve modulation, dorsal penile nerve stimulation and transcutaneous electric nerve stimulation are able to relieve detrusor hyperactivity. Electric stimulation is a good choice for the patients with spinal cord injury to overcome bladder dysfunction. Nevertheless, it is not popular in Taiwan. We should put more emphasis on this field in the future.

並列關鍵字

electric stimulation ； spinal cord injury ； bladder dysfunction